“Alexa, did I get enough exercise today?”

That’s the question researcher Ahmed Hassoon is encouraging cancer survivors to ask. With support from the Maryland Cigarette Restitution Fund, he has designed and conducted a clinical trial that showed Amazon’s virtual voice assistant may help overweight cancer survivors increase their daily activity and ultimately reduce the chance of their cancer coming back.

Inspired by mounting evidence that being overweight increases the risk of cancer recurrence and his own research interest in artificial intelligence solutions to improving patient outcomes, Hassoon launched the Physical Activity by Technology Help, or PATH, study. The study compared three types of motivators—written material, text messages and voice assistance technology, like Alexa—to see which was the best motivational tool to support weight loss.

Hassoon says affordability, accessibility and personalization are key. “Activity and weight loss goals vary from one person to the next, but not everyone can pay for a coach,” he says. He believes technology may provide an easy and cost-effective way to provide personalized attention that meets each person’s needs.

The PATH study was primarily aimed at helping African-American cancer survivors and had 42 participants. Over four weeks, Hassoon and team evaluated two technological approaches and one low-tech option aimed at encouraging overweight and obese cancer survivors (defined as having a body mass index of 25 or above) to get in 10,000 steps each day. Participants were healthy enough to exercise but not currently physically active. They wore exercise sensors in wristbands or belt clips, known as accelerometers, that work in conjunction with a smartphone to monitor and capture physical activity.

The study participants were divided into three groups: Coachtext, MyCoach and a control group. The Coachtext group received remote coaching via personalized text messages directly to their cellphones. The MyCoach group used Alexa, a conversational, voice-controlled artificial intelligent personal assistant delivered via an Amazon Echo home “smart” speaker installed by the research team in the participants’ homes. The MyCoach algorithm draws on data from a number of sources, including the patient study file, physical activity wearable sensor, user’s calendar, geography/location data and more. It can perform a variety of functions, such as offering feedback to the user, assisting in formulating habits, providing reminders and alarms, and offering health tips. The control group received written materials about the benefits of physical activity and were simply advised to increase their physical activity to 10,000 steps per day.

Hassoon’s research goal was to identify the best tools for motivating long-lasting behavioral change.

“Many patients will get bored in a few months,” Hassoon says. “It’s adherence. We need to determine how we can engage patients long term.”

Hassoon found that PATH participants varied widely in their understanding of the importance of physical activity and their readiness to incorporate it into their daily lives. “Some patients didn’t know that physical exercise could reduce their risk of cancer recurrence,” he says. “Other patients are very motivated. They just need guidance.”

The Alexa-assisted MyCoach group, whose participants had an average age of 59 and had little or no previous experience using voice-assisted devices, found themselves com-fortably conversing with MyCoach. “By the time we finished the trial, I probably had about 75 percent of the study participants pretty enthusiastic about using Alexa and 25 percent who were a little wary but willing to give it a try,” says Yasmin Baig, research coordinator for the study.

As voice-assisted and other emerging technologies become an increasingly integral part of people’s daily lives, Hassoon believes their application in translational research will also expand. “It’s a very cost-effective means of reaching out and delivering personalized advice and monitoring compared to conventional ways,” he says. “We think it saves tens of thousands of dollars without compromising the personal connection to patients.”